128 Efficacy and safety of deep brain stimulation in Parkinson’s disease: systematic review and meta-analysis

Background Deep brain stimulation (DBS) is a neurosurgical procedure indicated in patients with advanced Parkinson’s disease (PD). This systematic review and meta-analysis aimed to investigate the efficacy and safety of DBS in comparison to best medical therapy (BMT) in the treatment of PD. Methods A systematic search was performed in Medline, Embase and Central. Randomised controlled trials (RCTs) comparing DBS to BMT in PD patients were included. Outcome measures were impairment/disability (UPDRS), quality of life (PDQ-39), levodopa equivalent dose (LED) and rates of serious adverse events (SAE). Results Eight eligible RCTs (n=1189) were included in the meta-analysis. Regarding efficacy outcomes, there were significant improvements in UPDRS, PDQ-39 and LED in favour of DBS (P<0.00001). The risk of SAE was significantly higher in the DBS group (P=0.005), as was the total number of SAE (P<0.0018). Conclusions Overall, DBS was found superior to BMT at improving impairment/disability, quality of life and reducing medication doses, but these benefits need to be weighed against the higher risk of SAE.